Heart assist method and catheter

ABSTRACT

Method and device for augmenting the action of an ailing heart having an incompetent aortic valve, wherein blood is sucked up from the aorta, while blocking flow to the arterial tree, and then, upon reverse, a major portion of the blood is forced into the arterial tree and a minor portion forced into the coronary arteries of the heart itself.

United States Patent inventors David ll. Watkins 6039 N. Waterbury Road,Des Moinee, Iowa 50312; Erwin J. Klink, 814 Laurel Circle S.E.,Alilquerqne, N. Mex. 87108 Appl No 885,507

Filed Dee. I6, 1969 Patented July [3, i971 HEART ASSIST METHOD ANDCATHETER 5 Chi-54 Drawing Figs.

US. CL 128/1 R, I28/245, 128/348 Int. Cl. A61n1 1/03, A6ib l9/OOfieltlolsenrch l28/l R,

2l4, 348, 24l,245, 344; 3/l

[56] References Cited UNITED STATES PATENTS 3,071,137 l/l963 Niebel etal 128/348 X 3,266,487 8/1966 Watkins et al. 128/] R 3,426,743 2/i969Chesnut et al. I 28/1 R 3,472,230 10/1969 Fogarty v a v a 128/3453,504,662 4/1970 Jones i28/l R 3,516,410 6/1970 Hakim l28/245 X PrimaryExaminer- Dalton L. Truluck Anonleylohn Howard Joynt ABSTRACT: Methodand device for augmenting the action of an ailing heart having anincompetent aortic valve, wherein blood is sucked up from the aorta,while blocking flow to the arterial tree, and then, upon reverse, amajor portion of the blood is forced into the arterial tree and a minorportion forced into the coronary arteries of the heart itself.

PATENTEI] JUL 1 3H]?! 3, 592, l 84 SHEET 1 0F 2 INVENTORS David h!Watkins Enw' J link BY .fl

ATTORNEY PATENIED JUL 1 3 an SHEET 2 BF 2 m S w W m m a 1 WM A HJ V m w3 m HEART ASSIST METHOD AND CATHETER As a matterof introduction, ourinvention relates to method and apparatus for augmenting the action ofthe ailing heart of a patient.

Among the objects of our invention is the provision of a method and adevice for safely, effectively and reliably moving blood from theincompetent aortic valve of a failing heart and then discharging thesame into the arterial tree while supplying a minor portion of the bloodto the coronary arteries of the heart itself.

Other objects in part will be apparent and in part particularly pointedto in the description which follows.

Our invention may be considered to reside in the combination ofelements, features of construction and arrangement of parts and in theseveral operational steps and the relation of each of the same to one ormore of the others, all as described herein and set out in the claims atthe end of this specification.

CROSS-REFERENCE TO RELATED APPLICATION The present application forpatent is generally related to our application of May 27, I969, Ser. No.828,151 entitled Heart Assist Method and Apparatus.

BACKGROUND OF THE INVENTION In order to gain a better understanding ofcertain features of our invention, it is to be noted at this point thatsituations occur wherein the heart action of the patient is whollyinsuffi cient to supply the bodily needs. In certain of these instancesthe patient has an incompetent aortic valve. And blood pumped out of theleft ventricle of the heart partially flows back into the leftventricle, this as a result of the inability of the aortic valve toprevent the back flow. As a result, there is a loss of pressure, and aloss of blood supplied the arterial tree. Moreover, in many instancesthere is insufficient blood supplied the coronary arteries of the heartitself.

Although many efforts have been made in the past to overcome thedeficiencies of an ailing heart, and indeed to take ac.- count of anincompetent aortic valve, for one reason or another these have not beenentirely satisfactory. In some instances prior systems and apparatushave been too complicated. In others they have been either too costly ornot sufficiently reliable for most use.

An object of the present invention, therefore, is to provide a system,as well as a method and device, for overcoming the deficiencies of theprior art and assure effective movement of blood from an incompetentaortic valve of the heart and discharge a major portion of the same intothe arterial tree while at the same time supplying a minor portion tothe coronary arteries.

SUMMARY OF THE INVENTION Directing attention to the practice of ourinvention, we provide a method and device of novel construction. Acatheter is introduced into the aorta, or into the left subclavianartery, by means of an arterialotomy incision. The proximate end of thecatheter of course protrudes from the artery and is provided with aplastic tube connecting to a reciprocating pump and apparatus of thecharacter more generally shown and described in our copendingapplication for patent identified above. The distal end of the catheteris directed toward the heart. It is this end of the catheter which isprovided with one hole or port. Back from this first opening there isprovided a further hole or port. An expandible membrane is locatedcircumferentially and radially extending about the catheter at aposition between the two holes or ports referred to.

BRIEF DESCRIPTION OF THE DRAWINGS In the accompanying drawings in whichwe disclose two preferred embodiments of our invention:

FIG. I is the catheter of our invention on a somewhat enlarged scale;

FIG. 2 is a sectional view of the catheter of FIG. I as installed in theaorta of a patient at a position adjacent to the aortic valve;

FIG. 3 is a detached view ofa portion of the catheter of FIG. 1 onenlarged scale in order to best illustrate certain features of theinvention; and

FIG. 4 is a similar sectional view on an enlarged scale of an alternateembodiment of the catheter of our invention.

Like reference characters denote like parts throughout the several viewsof the drawings.

DESCRIPTION OF THE PREFERRED EMEODIM ENTS Turning now to a preferredembodiment of our invention, attention is directed to FIGS. 1, 2 and 3of the drawings. It is seen that our catheter essentially comprises ahollow shaft portion with proximate end 500 received and secured in tube29 leading to a suitable blood pump (not shown). The distal end of thecatheter is provided with a suitable port or opening 54 just back fromtip 50b (see FIG. The the distal end, moreover, is provided with afurther port 55 back from port 54. Surrounding the catheter at a pointbetween the ports 54 and 55 there is an expansible imperforate membrane52 serving as valve means exteriorly of said catheter. This is suitablysecured to catheter 50 and flares outwardly and circumferentially aboutthe same. The outer circumferential extremity of the flaring membrane issecured to catheter shaft 50 by suitable radial filaments SI.

During the cyclic operation of the blood pump associated with ourdevice, and connecting to the catheter by way of tube 29 as indicatedabove, with the suction stroke of the pump the blood coming from theaortic valve enters port 54. In this action a membrane valve means 56secured to the inner walls of the catheter adjacent the distal endthereofcollapses inwardly. Such action permits the free flow of bloodinto the catheter and to the pump. During this action any loss of bloodthrough the second port 55 is prevented by virtue of the collapse of theexteriorly mounted membrane valve means 57 (see FIG. 3) against theouter wall of the catheter. And any inflow of blood from the arterialtree toward the distal end of the catheter and into port 54 is preventedby the expansion of circumferential membrane 52. Membrane 52 also servesto prevent any collapse of the walls of the aorta under the reducedpressure conditions obtaining during this cycle in the pump.

With a reverse of pump action, that is, the discharge stroke, bloodflows back into the catheter by way of tube 29 and out through port 55into the aorta. During this action the exteriorly positioned membrane 57is expanded outwardly under the pressure of the blood and allows anunimpeded flow into the arterial tree.

It will be noted that port 54 adjacent to the distal end of the catheteris not completely closed by the interiorly positioned membrane 56. Theconstruction is such that there is provided a portion 54a that amountsroughly to some one-third the area of the entire port 54. As a result, asubstantial portion of the blood coming from the pump with the dischargestroke passes into the aorta near its distal end, this by way of port540, and effectively supplies the coronary arteries of the heart itself.While provision is made for sufficient blood to flow into the coronaryarteries, there is no undue reverse filling of the incompetent leftventricle.

A modified catheter construction is shown in FIG. 4 of the drawings. Inthis the distal end of the catheter is provided with a reciprocablesleeve 58, with valve means comprising closed end 60 and port 59. A lug61 provided on sleeve 58 rides back and forth in slot 50'0 provided inthe catheter wall. With the pressure stroke of the pump, movement ofsleeve 58 to the left, as seen in FIG. 4, is arrested by lug 61 strikingone end of slot 50'a, and with the suction stroke the reverse movementis arrested by the lug striking the other end of the slot.

During the suction stroke of the pump, sleeve 58 is drawn to the right.With this movement the walls of sleeve 58 effectively close port 55' ofthe catheter. And concurrently with this action, port 59 of sleeve 58 isbrought into register with port 54' of the catheter. Blood from theaorta then is sucked into catheter 50' by way of registered ports 54'and 59. Any flow of blood from the arterial tree under the back pressureof the tree and the suction conditions maintaining in the area of theaorta is prevented by the outward expansion of membrane valve 52.

With the reverse stroke of the pump during the discharge cycle of thesame, the reciprocable sleeve 58 is forced outwardly or to the left, asseen in the drawing, under the pressure conditions then maintaining.This provides free access of the blood to port 55' and thence to thearterial tree. Under the pressure action port 59 is brought forward fromregister with port 54' and extends somewhat beyond the end portion 50'bof the catheter, this providing an opening of the port equal to aboutone-third of that of port 59 itself. We conveniently refer to thisportion of the opening as 59a. While the major portion of the bloodexits through port 55', and thence to the arterial tree, a minor portionexits through port 5% to supply the coronary arteries. The amount ofthis minor portion, however, and the conditions of pressure associatedtherewith are not sufficient to discharge blood back into theincompetent left ventricle.

It will be seen that in the method and apparatus of our invention thecontent of the left ventricle of the heart is exhausted with a suctionstroke. Yet, even with an incompetent aortic valve, any backflow ofblood under the pressure condi tions obtaining with a succeedingdischarge stroke, there is no undue reverse filling as encountered withnormal operation of a defective heart with incompetent valve.

Thus, it will be seen that we provide in our invention a method andapparatus in which the various objects hereinbefore set forth aresuccessfully had. The method and apparatus is simple, direct andreliable.

Since many embodiments may be made of our invention, and since manychanges may be made in the embodiments hereinbefore set forth, it shouldbe understood that all matter described herein, or shown in theaccompanying drawings, is to be interpreted as illustrative, and not byway oflimitation.

We claim:

1. Method for augmenting the action of an ailing heart having associatedaorta and arterial tree supplied thereby and coronary arteries supplyingthe heart itself wherein an open ended catheter is inserted into theaortic, or left subclavian artery, to a point adjacent the aortic valve,comprising in sequential operation sucking blood from said aorta throughsaid catheter during systolic heart pulsation, while blocking backflowfrom the said arterial tree; and on reverse cycle forcing the majorportion of the said blood back through said catheter into the arterialtree while forcing a minor portion into the said coronary arteriesduring diastolic period.

2. Method according to claim I wherein about two-thirds of the blood onreverse cycle is supplied the arterial tree and about one-third issupplied the coronary arteries of the heart itself.

3 Heart assist device comprising catheter means including an elongatedmember with a bore extending therethrough and having a distal end withopening therein and a second opening back from said first-mentionedopening; expandible and imperforate membrane valve means flaring outcircumferentially and extending radially extending about said cathetermeans from a point between said two openings; valve means engaging saidcatheter closing said second opening upon a suction being established insaid catheter; and valve means within said catheter largely closing saidfirst-mentioned opening upon a pressure being established in saidcatheter.

4. Device according to claim 3 wherein said catheter engaging valvemeans is in the form of an expandible sleeve positioned externally ofsaid catheter and secured thereto; and said valve means within thecatheter is in the form of an expandible sleeve positioned internally ofsaid catheter and secured thereto. I I

5. Device according to claim 3 wherein said catheter engag-

1. Method for augmenting the action of an ailing heart having associatedaorta and arterial tree supplied thereby and coronary arteries supplyingthe heart itself wherein an open ended catheter is inserted into theaortic, or left subclavian artery, to a point adjacent the aortic valve,comprising in sequential operation sucking blood from said aorta throughsaid catheter during systolic heart pulsation, while blocking backflowfrom the said arterial tree; and on reverse cycle forcing the majorportion of the said blood back through said catheter into the arterialtree while forcing a minor portion into the said coronary arteriesduring diastolic period.
 2. Method according to claim 1 wherein abouttwo-thirds of the blood on reverse cycle is supplied the arteriAl treeand about one-third is supplied the coronary arteries of the heartitself.
 3. Heart assist device comprising catheter means including anelongated member with a bore extending therethrough and having a distalend with opening therein and a second opening back from saidfirst-mentioned opening; expandible and imperforate membrane valve meansflaring out circumferentially and extending radially extending aboutsaid catheter means from a point between said two openings; valve meansengaging said catheter closing said second opening upon a suction beingestablished in said catheter; and valve means within said catheterlargely closing said first-mentioned opening upon a pressure beingestablished in said catheter.
 4. Device according to claim 3 whereinsaid catheter engaging valve means is in the form of an expandiblesleeve positioned externally of said catheter and secured thereto; andsaid valve means within the catheter is in the form of an expandiblesleeve positioned internally of said catheter and secured thereto. 5.Device according to claim 3 wherein said catheter engaging valve meansand said valve means within said catheter comprise a single reciprocablechamber closely fitting within said catheter and having a first porttherein adapted to register with the said opening in the distal end ofthe catheter upon the suction cycle of operation, the walls of thechamber closing off said further opening in said catheter; and a secondport therein for but partially registering with and largely closing offsaid distal end opening upon application of pressure during thesucceeding cycle of operation.